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General NPI Number Information
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NPI Number | 1053501700
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Entity Type | Organization
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Legal Business Name | RONALD G. BASALYGA, M.D. PC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 4711 PINECREST TER
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City | EDEN
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State | NY
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Zip | 14057-9757
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Country | US
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Telephone | 716-649-5188
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Fax | 716-649-5188
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Provider Business Mailing Address
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Address Line | 4711 PINECREST TER
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City | EDEN
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State | NY
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Zip | 14057-9757
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Country | US
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Telephone | 716-649-5188
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Fax | 716-649-5188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD G. BASALYGA
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Credential |
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Telephone | 716-649-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 095710
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License Number State | NY
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